Blood Res.  2013 Dec;48(4):287-291. 10.5045/br.2013.48.4.287.

Nodular lymphoid hyperplasia of the stomach in a patient with multiple submucosal tumors

• Jeon JY
• Lim SG
• Kim JH
• Lee KM
• Cho SR
• Han JH

• KMID: 2172877
• DOI: http://doi.org/10.5045/br.2013.48.4.287

Abstract

Nodular lymphoid hyperplasia of the stomach is a rare lymphoproliferative disorder. Here, we report a 38-year-old man who presented with multiple submucosal tumors of the stomach. Histologically, the lesions were characterized by multiple discrete submucosal nodules of lymphoid cells. The infiltrates between the lymphoid follicles were composed mainly of medium-sized lymphoid cells with abundant clear cytoplasm, as well as a few large cells with vesicular nuclei. The gastric mucosa exhibited multifocal lymphoid aggregates and some of the epithelial cells were infiltrated by small lymphocytes mimicking lymphoepithelial lesions. Histopathology was consistent with mucosa-associated lymphoid tissue lymphoma. However, the infiltrating lymphoid cells were positive for CD2, CD3, CD5, and CD7. In addition, polymerase chain reaction analysis of the immunoglobulin heavy chain and T-cell receptor gene rearrangements demonstrated polyclonality. This case was diagnosed as reactive lymphoid hyperplasia of the stomach.

Keyword

Lymphoid hyperplasia; Stomach; MALToma

MeSH Terms

Adult
Cytoplasm
Epithelial Cells
Gastric Mucosa
Genes, T-Cell Receptor
Humans
Hyperplasia*
Immunoglobulin Heavy Chains
Lymphocytes
Lymphoma, B-Cell, Marginal Zone
Lymphoproliferative Disorders
Polymerase Chain Reaction
Pseudolymphoma
Stomach*
Immunoglobulin Heavy Chains

Figure

• 

  Fig. 1 (A) Endoscopy of the stomach showing multiple protruding mass-like lesions without mucosal change. (B) Endoscopic ultrasound imaging showing well-demarcated, oval, hypoechoic lesions of various sizes, originating in the submucosal layer without invading the deeper layers.

• 

  Fig. 2 (A) The resected polyps revealed two well-defined submucosal nodules of dense lymphoid infiltrates mimicking ectopic lymph nodes (original magnification ×2). (B) The lymphoid infiltrates had a diffuse and nodular architecture with primary or secondary lymphoid follicles (original magnification ×40). (C) A few lymphoid follicles had a prominent mantle zone and small germinal centers (original magnification ×100). (D) The lymphoid cells in the primary follicles were composed predominantly of small cells and a few multinucleated giant cells, which were considered to be follicular dendritic cells (original magnification ×400). (E) The infiltrate between the follicles was composed mainly of medium-sized lymphoid cells with abundant clear cytoplasm and indented or round nuclei with small nucleoli. A few large cells with vesicular nuclei and one or two prominent nucleoli were identified (original magnification ×400). (F) The gastric mucosa revealed multifocal lymphoid aggregates, and some of the epithelial cells were infiltrated by small lymphocytes mimicking lymphoepithelial lesions (original magnification ×400).

• 

  Fig. 3 (A) and (B) The lymphoid infiltrates, including the medium-sized cells in the interfollicular areas, were diffusely positive for CD3, but the small cells in the lymphoid follicles and large cells in the interfollicular areas were not (original magnifications ×40 (A) and ×400 (B)). (C) and (D) However, the latter cell types expressed CD20 (original magnifications ×40 (C) and ×400 (D)). (E) Bcl-6-positive B lymphoid cells were confined to small germinal centers (original magnification ×40). (F) Staining with CD21 showed a normal reactive pattern in the lymphoid follicle (original magnification ×100).

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